The Health Consequences of Senior Hunger in the United ... · heart disease, heart attack cancer, asthma, gum disease, and psoriasis.1 Other reports are from the respondent’s own

The Health Consequences of Senior Hunger

in the United States: Evidence from the

1999-2010 NHANES

Prepared for the National Foundation to End Senior Hunger

February 2014

Professor James P. Ziliak Professor Craig Gundersen

University of Kentucky University of Illinois

ACKNOWLEDGEMENTS

This report was made possible by a generous grant from the National Foundation to End Senior

Hunger. The conclusions and opinions expressed herein are our own and do not necessarily

represent the views of any sponsoring agency.

ii

Executive Summary

Millions of seniors are food insecure in the United States, meaning that scores do not have access

to enough food at all times for an active, healthy life. What makes food insecurity an even more

pressing issue is its association with a wide array of negative nutrition and health consequences.

In our earlier reports on food insecurity among seniors (Ziliak et al., 2008; Ziliak and Gundersen,

2011) we documented that food insecure seniors, even after controlling for other factors, were at

higher risk of experiencing negative nutrition and health consequences than food secure seniors.

In this report we build on those earlier findings in three main directions. Namely, we add in

several new health outcomes; we use four more years of data ; and we examine how trends in

health and nutrition outcomes among food secure and food insecure seniors have changed over

the past decade. Using data from the 1999-2010 National Health and Nutrition Examination

Survey (NHANES), we considered the following outcomes related to nutrient intakes: energy

intake, protein, vitamin A, vitamin C, thiamin, riboflavin, vitamin B6, calcium, phosphorous,

magnesium, and iron. The set of health outcomes we analyzed were diabetes, general health ,

depression, diabetes, ADL limitations, high blood pressure, high cholesterol, congestive heart

failure, coronary heart disease, cancer, reports of chest pain, gum disease, psoriasis, asthma,

having had a heart attack, and a self-report of gum health. Here we summarize some of our

principal findings.

Food insecure seniors have lower nutrient intakes. For each of the eleven nutrients, average

intakes are statistically significantly lower generally by 10-20 percent for food insecure seniors

in comparison to food secure seniors. After controlling for other confounding factors, the effect

of food insecurity is still negative for each of the nutrients albeit in some of the cases, the effect

is statistically insignificant. These differences in health outcomes held across time.

Food insecure seniors have worse health outcomes. For a wide array of health outcomes, food

insecure seniors are worse-off than food secure seniors. Namely, they are 50 percent more likely

to be diabetic, twice as likely to report fair or poor general health, three times more likely to

suffer from depression, 30 percent more likely to report at least one ADL limitation, 14 percent

more likely to have high blood pressure, nearly 60 percent more likely to have congestive heart

failure or experienced a heart attack, and twice as likely to report having gum disease or have

asthma. These differences were present in both the aggregate and for each four-year time period

we examined. And, with the exception of gum disease, these worse outcomes hold even after

controlling for other factors, though attenuated in magnitude.

The effect of food insecurity holds even for a lower-income sample. As shown in Ziliak and

Gundersen (2013), food insecurity rates are substantially higher for those with incomes less than

200% of the poverty line. So, we investigated whether or not the negative association of food

insecurity with nutrient intakes and health remain even when we limit our multivariate analyses

to those with incomes below 200% of the poverty line. We find that, in the main, the substantive

and statistical significance of the results are quite similar to those for the full sample. This

further demonstrates the importance of looking at food insecurity as an independent predictor of

negative health and nutrition outcomes, even among lower-income seniors.

3

I. Introduction

Food insecurity has been associated with a wide array of negative health outcomes both

among the young and old. Among children and working-age adults, recent research has shown

that households suffering from food insecurity are more likely to incur higher risks of some birth

defects (Carmichael et al., 2007), anemia (Eicher-Miller et al., 2009; Skalicky et al., 2006), lower

nutrient intakes (Cook et al., 2004), greater cognitive problems (Howard, 2011), higher levels of

aggression and anxiety (Whitaker et al., 2006), higher probabilities of being hospitalized (Cook

et al., 2006), poorer general health (Cook et al., 2006; Gundersen and Kreider, 2009), higher

probabilities of asthma (Kirkpatrick et al., 2010), higher probabilities of behavioral problems

(Huang et al., 2010), and more instances of oral health problems (Muirhead et al., 2009). Among

adults some of the consequences of food insecurity include lower nutrient intakes (Kirkpatrick

and Tarasuk, 2007; McIntyre et al., 2003), mental health problems (Heflin et al., 2005), physical

health problems (Tarasuk, 2001), depression (Whitaker et al., 2006), diabetes (Seligman et al.,

2007), and higher levels of chronic disease (Seligman et al., 2009). In Ziliak, et al. (2008) and

Ziliak and Gundersen (2011) we established that food insecurity has serious consequences for

seniors, even controlling for other known health risks. These reports are consistent with other

work that has found that food insecurity (or similar measures of food hardship) are associated

with negative health outcomes (e.g., Bhargava et al. (2012), Champagne et al. (2007); Holben et

al. (2006), Kim and Frongillo (2007), Klesges et al. (2001), Lee and Frongillo (2001), Sattler and

Lee (2012), Sharkey (2003)).

In this report, we build on this research in three main directions. First, we consider a

much wider array of health outcomes in addition to nutrient intakes including high blood

4

pressure, high cholesterol, congestive heart failure, coronary heart disease, heart attack, cancer,

chest pain, gum disease, ratings of gum health, psoriasis, and asthma. Second, we add four more

years of data. By looking at 1999-2010 data from the National Health and Nutritional

Examination Survey (NHANES), we are able to utilize a larger-sample size which is especially

relevant for some demographic groups, and in particular examining whether substantive health

consequences hold for a low-income subsample. Third, building on the additional data, we now

can examine trends in nutrition and health outcomes across food security status for the entire first

decade of the 21st Century. As shown in Ziliak and Gundersen (2013), the rates of food

insecurity among seniors has increased dramatically over the past decade, and in this report we

are the first to document whether there are attendant health consequences.

II. Data

The NHANES, conducted by the National Center for Health Statistics, Centers for

Disease Control (NCHS/CDC), is a program of studies designed to assess the health and

nutritional status of adults and children in the United States through interviews and focused

physical examinations. The survey now examines a nationally representative sample of about

5,000 persons each year, about half of whom are adults. The interview includes demographic,

socioeconomic, dietary, and health-related questions and health assessments consisting of

medical and dental examinations, physiological measurements and laboratory tests. Vulnerable

groups, including persons over 60, are oversampled in the NHANES to produce more reliable

statistics. We use weights constructed by NHANES that are applicable for samples pooled

across years. The data in the NHANES is constructed such that two years’ worth of data are

combined to form one wave. So, when we present the results in the tables below, the results are

combined into 1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, and 2009-2010.

5

For the analyses here, we use data from multiple NHANES modules. Of particular

importance to the analyses here is, of course, the presence of the full Core Food Security Module

(CFSM) on the food security supplement. In this study, to make things comparable to the

central analytical framework in our report on food insecurity (Ziliak and Gundersen, 2013), we

compare seniors in food insecure households with seniors in food secure households. Consistent

with the official definitions, a senior is in the former category if the household responds

affirmatively to three or more questions from the CFSM and in the latter category if the

household responds affirmatively to two or fewer questions.

For nutrient intakes we consider variables measuring energy intake, protein, vitamin A,

vitamin C, thiamin, riboflavin, vitamin B6, calcium, phosphorous, magnesium, and iron. These

are all based on individual’s self-reports of their food consumption for two full days.

For health outcomes, we include individuals’ self-reports of various outcomes. These are

asked of all respondents over the age of 60. Some of the questions are based on whether or not a

medical health professional has ever told someone they have a certain medical condition. This is

the case for diabetes, high blood pressure, high cholesterol, congestive heart failure, coronary

heart disease, heart attack cancer, asthma, gum disease, and psoriasis.1 Other reports are from

the respondent’s own perception of current well-being including reports of chest pain, general

health (excellent, very good, good, fair, or poor), depression, and whether or not someone can do

activities of daily living. In addition, we include a variable for whether or not someone has ever

had a heart attack and a self-report of gum health (from excellent to poor).2

1 Some of these outcomes could have been far in the past (e.g., a cancer diagnosis) and/or no longer impairing

someone’s current well-being (e.g., a respondent whose blood cholesterol is now lower). In addition, there may be

some persons who currently or in the past have had some of these conditions but because they did not see a health

professional, they are unaware of the health issue. 2 For each question, the respondent has the choice to not respond or answer “don’t know”.

6

III. Results

In this section we begin with descriptive associations between food insecurity and health

outcomes for the full sample of all individuals using the updated NHANES dataset, and examine

descriptive differences in nutrition and health outcomes across several demographic categories.

We then more formally model the relationship between food insecurity and health with

multivariate regression models.

III.A. Health Outcomes across Food Security Status

In Table 1A we display the mean values of our key nutrition outcomes broken down by

food insecurity status. All of the analyses, except for the multivariate models, use weights

supplied in the NHANES.

Intakes are lower for each nutrient for food insecure seniors in comparison to food secure

seniors, and these differences can be quite large. 3

Consider four measures of nutrient intake for

seniors that are especially important for seniors—energy intake, protein, calcium, and iron. Out

of these nutrients, food insecure seniors have intakes that are 11.4 percent, 11.9 percent, 10.0

percent, and 13.7 percent lower than food secure seniors, respectively.

When we consider broader measures of health outcomes (Table 1B), a similar story

emerges for most outcomes. In terms of self-reports of general health, individuals experiencing

food insecurity are worse-off. For example, 38 percent of food secure individuals report

excellent or very good health versus 12 percent of food insecure individuals, and 73 percent of

food secure individuals report excellent, very good, or good health versus 45 percent for food

insecure individuals. Rates of depression among food insecure seniors are markedly higher (233

percent) than among food secure seniors. Alongside these worse outcomes, food insecure

3 Unless otherwise noted, the differences discussed are statistically significant with p-values less than 0.05. For the

results in Table 1, the p-values are all less than 0.01 with the exception of iron which is less than 0.05.

7

seniors are 32 percent more likely to suffer from at least one ADL limitation, 57 percent more

likely to report congestive heart failure, twice as likely to report asthma, and are more 60 percent

likely to have had a heart attack. Food insecure seniors also report worse gum health. The only

dimension where food secure seniors are worse off than food insecure seniors is with respect to

cancer where 23 percent of food secure seniors have had cancer versus 13 percent of food

insecure seniors.4

III.B. Health Outcomes over Time and Food Security Status

We now consider whether the relationship between food insecurity and nutrition and

health outcomes change over time. This may be especially relevant if there were changes in the

relative relationships over time due to the Great Recession when rates of food insecurity soared

over 30 percent (Ziliak and Gundersen 2013). For these figures, we concentrate on select

nutrients and for health outcomes which show statistically significant differences when averaged

over all the years. When we examine food secure households, the large sample sizes allow one

to examine individual waves. However, the relatively small sample sizes for food insecure

households means that to derive more reliable measures of change over time, we pool two waves

worth of data. So, to that end, in what follows we examine three points in time – 1999-2002,

2003-2006, and 2007-2010.

In Figures 1 through 4 we present time series trends for four nutrient intake measures:

total energy, protein, calcium, and iron. Consistent with the pooled cross-sectional averages in

Table 1, food insecure seniors have lower intakes of each of these measures in every time period

examined compared to food secure seniors but there are differences in patterns over time. For

total energy and especially for iron, the gap between food secure and food insecure seniors

4 The question regarding cancer is not regarding whether or not someone currently has cancer but, rather, whether

someone has ever had cancer.

8

narrows somewhat over time. For protein and iron, the gap is smaller in 2003-6 than the other

time periods.

In Figures 5 through 12 we display results for the some of the health outcomes in Table

1B. The outcomes we consider are diabetes, depression, ADL limitations, high blood pressure,

congestive heart failure, ever having a heart attack, chest pain, and asthma.5 For each of the

three time periods for all the variables, the health outcomes of food insecure seniors are worse

than food secure seniors. For most of the health outcomes, the levels for both food insecure and

food secure seniors remained relatively constant throughout and, consequently, so too did the

gap between the groups. The exceptions were for chest pain which, while the gap remained

similar, there was a steady decline for both groups and for diabetes and congestive heart failure

the gap increased over the middle time period. Even though food insecurity rates increased

dramatically after the Great Recession, for most of the health outcomes considered the gaps

between food secure and food insecure did not worsen.

III.C Demographic Differences in Health Outcomes across Food Security Status

In Tables 2 through 18 we present the results for demographic groups in the NHANES

for which there were at least 500 observations. These tables are further broken down by nutrient

intakes (A) and health outcomes (B), but not by year owing to small of sample sizes by

demographic group. 6

The groups were selected on the basis of the results in Ziliak, et al. (2008)

and Ziliak and Gundersen (2013) that showed that certain subpopulations of seniors were at

greater risk of food insecurity, e.g. by income, race, and education.

5 Questions on the conditions of one’s gums differed from year-to-year and so we do not examine changes over

time. The questions on general health only were asked in 2001 and subsequent years so we do not include this

variable, either. 6 As noted in the previous footnote, questions on the conditions of one’s gums differed from year-to-year. One

implication is that there is not a large enough sample size for the two variables related to gum health when things are

broken down by demographic categories. A similar story holds for psoriasis.

9

With respect to marital status, food secure and food insecure seniors who are married or

widowed have significantly different nutrient intakes for each of the 11 measures with few

exceptions (Tables 2A and 3A). In contrast, in the other marital category (not married; not

widowed) food insecure seniors have similar intakes (Table 4A). In general, like for the full

population, food insecure seniors across marital status have worse health outcomes over the

dimensions discussed above than food secure seniors. But there are exceptions. Married seniors

who are food insecure, in comparison to food secure married seniors, are less likely to have had a

heart attack and more likely to have had cancer (Table 2B). With the exception of diabetes and

general health, widowed food insecure and food secure seniors have similar health outcomes

(Table 3B) and, consistent with this, while still statistically significantly higher, food secure

widows have more diminished differences with food insecure seniors then for the full population.

Table 4B for those not married or widowed is quite similar in terms of differences to Table 1B.

Turning to income, for seniors with incomes below 200% of the poverty line differences

between food secure and food insecure seniors in terms of nutrient intakes are more muted but

still statistically significant for all the nutrients except riboflavin, calcium, and phosphorous

(Table 5A). For health outcomes, the differences are similar in terms of statistically significant

differences (with the exception of excellent versus other levels of general health, congestive

heart failure, and having a heart attack) but the differences are again more muted (Table 5B).

Comparisons by food security status for those with incomes above 200% of the poverty line are

similar to the full population (Tables 6A and 6B). It is noteworthy that across nearly all nutrient

categories the food secure living below 200 percent of poverty have lower intakes than the food

insecure living above 200 percent of poverty, but in terms of general health the two groups are

more comparable.

10

Tables 7A and 7B are for female seniors. The results are similar to the population as a

whole for both nutrient intakes and health outcomes. A similar story holds for male seniors

(Tables 8A and 8B). There are qualitative gender differences in nutrient intakes across food

security status, but those differences are less pronounced among general health outcomes.

For African-American seniors, the nutrient intakes are qualitatively lower among the food

insecure, but are statistically significantly different only for thiamin, Vitamin B6, and

magnesium (Table 9A). For health outcomes, there are no statistically significant differences for

being in excellent health, high blood pressure, cancer, or gum health; the other outcomes are

qualitatively similar to the full population (Table 9B). For Hispanics, with the exception of

Vitamin C, there are no statistical differences in nutrient intakes by food insecurity status (Table

10A) and, with the exception of general health, ADL limitations, and chest pain, there are no

substantive or statistical differences in health outcomes by food insecurity status (Table 10B).

As expected, when the sample is restricted to senior whites, the results are similar to the full

population (Tables 11A and 11B).

Turning to education status, food insecure and food secure seniors with a high school

degree have similar nutrient intakes with the exception of Vitamin C (Table 12A). For health

outcomes, food insecure seniors with a high school degree are worse-off with similar patterns as

found for the full population results with the exception of diabetes and high blood pressure

which are now statistically insignificant (Table 12B). For seniors who did not graduate from

high school, the results are similar to the full population with the exception of high blood

pressure which is statistically insignificant (Tables 13A and 13B). Again, like we saw earlier

with the 200 percent of poverty sample, the nutrient intakes of food secure high school dropouts

11

are lower than the food insecure sample with high school and beyond, and the health outcomes

broadly similar with some exceptions such as reports of depression.

Finally, we consider differences between food insecure and food secure seniors by age:

60-65 years old, 66-70, 71-75, 76-80, and 81 or more (Tables 14A, 14B, 15A, 15B, 16A, 16B,

17A, 17B, 18A, 18B). For younger seniors the results largely mimic those of the full population

of seniors seen in Tables 1A and 1B. For the youngest seniors, there are some additional

variables that are statistically significantly different by food insecurity status - high cholesterol,

and coronary heart disease. Moreover, the gaps between food insecure and food secure seniors in

this age group are substantially larger for many of the outcomes. For the oldest seniors, the

differences in health outcomes by food insecurity status remain but, in many cases, the

differences are not statistically significant and, in general, the differences are more muted, even

when statistically significant.

III.D. The Association of Food Insecurity with Nutrition and Health Outcomes

We now turn to our analysis of the effect of food insecurity on health outcomes when we

control for other known risk factors which may also influence health outcomes. As with the

previous tables and figures, we estimate these models using data from the 1999-2010 NHANES.

Formally, we estimate the following model for the determinants of health outcomes (OUT) as:

OUTij = fj(FIi, Xi)

where i denotes a senior; j denotes either a nutrient intake or health condition; FI is equal to 1 if a

senior is in a food insecure household, 0 otherwise; and Zi is a vector of household demographic

and economic factors and wave fixed effects. For continuous measures, we estimate this using

OLS and for binary measures, probit model. For the probit results we report the marginal effects

12

evaluated at the means rather than the coefficients, which do not have a ready quantitative

interpretation.

As seen in Table 19A, even after controlling for other factors, food insecurity has a

substantive and statistically significant negative association with the intakes of energy, protein,

vitamin C, thiamin, riboflavin, vitamin B6, magnesium, and iron. For example, controlling for

other confounding factors, energy intake among food insecure seniors is 74 kcal lower, which is

about 4 percent lower than the average intake among food secure. A similar quantitative effect

holds for protein intakes, while the 7.5 mg lower Vitamin C is 8 percent lower than the mean in

Table 1A among food secure. These effects are about one-half the size reported in the

unadjusted means of Table 1A, indicating that the other half owes to differences in income,

education, race, marital status, and age between food secure and food insecure seniors. That is,

when significant, the other variables in our models have the expected association with health

outcomes. For example, for energy, intakes are higher among seniors with more income7, males,

non-Hispanic whites, high school graduates, and younger seniors. The differences between the

bivariate results in Table 1A, where all of the differences between food insecure and food secure

seniors were statistically significant, and those here demonstrate the importance of controlling

for other factors when estimating the impact of food insecurity.

With respect to health outcomes, the association of food insecurity with health outcomes

is also generally consistent with the results of Table 1B. As seen in the first page of Table 19B,

for each of the health outcomes with the exception of diabetes and the narrowest general health

7 In the NHANES, income is only reported within bounds. (E.g., between $5,001 and $10,000.) NHANES then

translates this information into a ratio of income to the poverty line. A small number of Seniors reported incomes of

less than $20,000 or more than $20,000 rather than the more narrow bounds. In these cases, NHANES did not

assign a ratio of income to the poverty line. Because we do not want to delete these observations from our samples,

we assign these households an income-to-poverty level value of the averages within the groups reporting their

incomes within the more narrow bounds.

13

comparison (excellent versus very good, good, fair, or poor health), food insecurity has a

negative association with positive health outcomes and a positive association with negative

health outcomes. And, in many cases, the effects are especially large when compared with other

covariates. For example, being food insecure, in terms of its association with ADL limitations is

roughly equivalent to being 14 years older. In the second page of Table 19B, like in Table 1B,

high blood pressure, congestive heart failure, and heart attack are all negatively associated with

food insecurity. However, coronary heart disease, after controlling for other factors, has a not

unexpected association with food insecurity. Finally, in the third page of Table 19B, chest pain,

gum health, and asthma are all directly associated with food insecurity. In contrast, the result in

Table 1B that food insecure seniors have lower probabilities of cancer in comparison to food

secure seniors disappears once we control for other factors.

As we pointed out in Ziliak et al. (2008) and Ziliak and Gundersen (2011), unlike for

nutrient intakes, the causality is not as clear with these relationships. For example, someone

suffering from ADL limitations may be less able to get to the store to purchase food in

comparison with someone who is readily able to perform such daily functions as bathing, eating,

and dressing. Nevertheless, the associations in the tables discussed above are, in general, in the

anticipated directions.

The rates of food insecurity among lower-income seniors are far higher than those with

higher incomes. As seen in Table 1 in Ziliak and Gundersen (2013), 27.7 percent of seniors with

incomes below the poverty line are food insecure and 16.2 percent of seniors with incomes

between the poverty line and 200% of the poverty line are food insecure. In contrast, the food

insecurity rate for seniors with incomes above 200% of the poverty line is 6.6 percent. We

14

therefore now consider whether the associations of food insecurity with health outcomes are still

present when we restrict the sample to those at greater risk of food insecurity.

Table 20A shows the results for the nutrient intakes covered above. In 19A, food

insecurity, after controlling for relevant covariates, is negatively associated with energy, protein,

vitamin C, thiamin, riboflavin, vitamin B6, magnesium, and iron. In Table 20A food insecurity

continues to be statistically significant in all of these except riboflavin. And, phosphorous is

statistically significant in this low-income sample even though it was not in the full sample.

In Table 20B, we consider the associations of food insecurity with health outcomes for

the lower-income sample. In comparison to Table 19B, the association of food insecurity with

the health outcomes are, as expected, more muted. The patterns of statistical significance are

the same as the full sample with the exception of excellent health versus very good, good, fair, or

poor health which is now statistically insignificant. In the second page of Table 20B, the

association of food insecurity with high blood pressure, congestive heart failure, and heart attack

are all positive and statistically significant. Finally, the third page of Table 20B shows that food

insecurity is positively and statistically significantly associated with chest pain and asthma, just

like in the full sample.

IV. Conclusions

In these concluding remarks we emphasize four major findings from our analyses of the

NHANES from 1999 through 2010. First, we find that food insecure seniors are on average

worse off than food secure seniors for each nutritional outcome and most health measures we

analyze. These gaps in well-being have remained generally constant over the past decade, even

though rates of food insecurity accelerated. Second, the general pattern that food insecure

seniors are worse-off with respect to health and nutrition outcomes than food secure seniors

15

holds even when we restrict our samples to distinct demographic categories. To put this a

different way, there are no common demographic groups which are immune to the negative

impacts of food insecurity. Third, we find that the disadvantage facing food insecure seniors

with respect to health outcomes persists even controlling for other known risk factors for poor

health. This further reinforces the need to look at food insecurity as a policy-relevant measure,

independent of other measures of well-being (e.g., income). Fourth, further buttressing the

previous point, even when the sample is restricted to those with lower incomes, food insecurity

still is associated with worse nutrition and health outcomes.

16

V. References

Bhargava V, Lee JS, Jain R, Johnson MA, Brown A. Food insecurity is negatively associated

with home health and out-of-pocket expenditures in older adults. Journal of Nutrition

2012;142:1888–95.

Carmichael S, Yang W, Herring A, Abrams B, Shaw G. Maternal food insecurity is associated

with increased risk of certain birth defects. Journal of Nutrition 2007;137:2087-2092.

Champagne C, Casey P, Connell C, Stuff J, Gossett J, Harsha D, McCabe-Sellers B, Robbins J,

Simpson P, Weber J, Bogle M. Poverty and food intake in rural America: Diet quality is lower in

food insecure adults in the Mississippi delta. Journal of the American Dietetic Association

2007;107(11):1886-1894

Cook J, Frank D, Berkowitz C, Black M, Casey P, Cutts D, et al. Food insecurity is associated

with adverse health outcomes among human infants and toddlers. Journal of Nutrition

2004;134:1348-1432.

Cook J, Frank D, Levenson S, Neault N, Heeren T, Black M, et al. Child food insecurity

increases risks posed by household food insecurity to young children’s health. Journal of

Nutrition 2006;136:1073-1076.

Eicher-Miller H, Mason A, Weaver C, McCabe G, Boushey C. Food insecurity is associated with

iron deficiency anemia in U.S. adolescents. American Journal of Clinical Nutrition

2009;90:1358-1371.

Heflin C, Siefert K, Williams D. Food insufficiency and women’s mental health: Findings from a

3-year panel of welfare recipients. Social Science and Medicine 2005;61:1971-1982.

Holben D, Barnett M, Holcomb J. Food insecurity is associated with health status of older adults

participating in the Commodity Supplemental Food Program in a rural Appalachian Ohio county.

Journal of Hunger and Environmental Nutrition, 2006;1(2):89-99.

Howard L. Does food insecurity at home affect non-cognitive performance at school? A

longitudinal analysis of elementary student classroom behavior. Economics of Education Review

2011;30:157-176.

Huang J, Matta Oshima K, Kim Y. Does food insecurity affect parental characteristics and child

behavior? Testing mediation effects. Social Service Review 2010;84:381-401.

Kim K, Frongillo E. Participation in food assistance programs modifies the relation of food

insecurity with weight and depression in elders. Journal of Nutrition, 2007;137: 1005-1010.

Kirkpatrick S, Tarasuk V. Food insecurity is associated with nutrient intakes among Canadian

adults and adolescents. Journal of Nutrition 2007;138:604-612.

17

Kirkpatrick S, McIntyre L, Potestio M. Child hunger and long-term adverse consequences for

health. Archives of Pediatric and Adolescent Medicine 2010;164 (8):754-762.

Klesges L, Pahor M, Shorr R, Wan J, Williamson J, Guralnik J. Financial difficulties in

acquiring food among elderly disabled women: Results from the Women’s Health, and Aging

Study.” American Journal of Public Health 2001;91:68-75.

Lee J, Frongillo E. Nutritional and health consequences are associated with food insecurity

among U.S. elderly persons. Journal of Nutrition, 2001;131:1503-1509.

McIntyre L, Glanville T, Raine K, Dayle J, Anderson B, Battaglia N. Do low-income lone

mothers compromise their nutrition to feed their children? Canadian Medical Association

Journal 2003;198:686–691.

Muirhead V, Quiñonez C, Figueiredo R, Locker D. Oral health disparities and food insecurity in

working poor Canadians. Community Dentistry and Oral Epidemiology 2009;37:294-304.

Sattler E, Lee J. Persistent food insecurity is associated with higher levels of cost-related

medication non-adherence in low-income older adults. Journal of Nutrition in Gerontology and

Geriatrics 2012;32(1):41-58.

Seligman H, Bindman A, Vittinghoff E, Kanaya A, Kushel M. Food insecurity is associated with

diabetes mellitus: results from the National Health Examination and Nutritional Examination

Survey 1999-2002. Journal of General and Internal Medicine 2007;22: 1018-1023.

Seligman H, Laraia B, Kushel M. Food insecurity is associated with chronic disease among low-

income NHANES participants. Journal of Nutrition 2009;140: 304-310.

Sharkey J. Risk and presence of food insufficiency are associated with low nutrient intakes and

multimorbidity among homebound older women who receive home-delivered meals. Journal of

Nutrition 2003;133(11):3485-3491.

Skalicky A, Meyers A, Adams W, Yang Z, Cook J, Frank D. Child food insecurity and iron

deficiency anemia in low-income infants and toddlers in the United States. Maternal and Child

Health Journal 2006;10(2):177–185.

Stuff J, Casey P, Szeto K, Gossett J, Robbins J, Simpson P, et al. Household food insecurity is

associated with adult health status. Journal of Nutrition 2004;134:2330-2335.

Tarasuk V. Household food insecurity with hunger is associated with woman’s food intakes,

health and household circumstances. Journal of Nutrition 2001;131:2670-2676.

Whitaker R, Phillips S, Orzol S. Food insecurity and the risks of depression and anxiety in

mothers and behavior problems in their preschool-aged children. Pediatrics. 2006;118: e859-

e868.

18

Ziliak J, Gundersen C. Food Insecurity among Older Adults. Report submitted to AARP

Foundation.

Ziliak J, Gundersen C. The State of Senior Hunger in America 2011: An Annual Report.

Supplement. Special Report by the University of Kentucky Center for Poverty Research for the

National Foundation to End Senior Hunger. 2013.

Ziliak J, Gundersen C, Haist M. The Causes, Consequences, and Future of Senior Hunger in

America. Special Report by the University of Kentucky Center for Poverty Research for the

Meals on Wheels Association of America Foundation. 2008.

19

Table 1A. Nutrition Outcomes by Food Insecurity Status for Seniors, Full Sample

Food Secure Food Insecure

(1) (2)

Nutrient intakes

Energy Intake (kcal) 1787.72 1583.66**

Protein (gm) 69.74 61.45**

Vitamin A (mcg) 661.13 541.30**

Vitamin C (mg) 89.47 67.38**

Thiamin (mg) 1.50 1.29**

Riboflavin (mg) 2.03 1.77**

Vitamin B6 (mg) 1.80 1.48**

Calcium (mg) 801.83 721.41**

Phosphorous (mg) 1165.35 1035.23**

Magnesium (mg) 268.86 231.42**

Iron (mg) 14.60 12.60**

Notes: Food secure is defined as 2 or fewer affirmative responses in the Core Food Security Module; food insecure

is defined as 3 or more affirmative responses. * Different from column (1), p ≤ 0.05. ** Different from column (1),

p≤ 0.01.

20

Table 1B. Health Outcomes by Food Insecurity Status for Seniors, Full Sample


(1) (2)

Diabetic 0.17 0.26**

Self-Reports of General Health

Excellent 0.10 0.03**

Excellent or very good 0.38 0.12**

Excellent, very good, or good 0.73 0.45**

Suffers from depression 0.03 0.10**

At least one ADL limitation 0.65 0.86**

High blood pressure 0.56 0.64**

High cholesterol 0.54 0.57

Congestive heart failure 0.07 0.11*

Coronary heart disease 0.11 0.11

Heart attack 0.10 0.16**

Cancer 0.23 0.13**

Reports of chest pain 0.32 0.43**

Gum disease 0.11 0.22*

Gum health? (1-excellent 5-poor) 2.69 3.45**

Psoriasis 0.04 0.03

Asthma 0.11 0.21** Notes: Food secure is defined as 2 or fewer affirmative responses in the Core Food Security Module; food insecure


p≤ 0.01.

21

Table 2A. Health Nutrients by Food Insecurity Status for Seniors, Sample of married


(1) (2)

Nutrient intakes


Protein (gm) 73.22 62.46**

Vitamin A (mcg) 659.10 502.08**

Vitamin C (mg) 91.51 64.33**

Thiamin (mg) 1.56 1.35**


Vitamin B6 (mg) 1.87 1.51**

Calcium (mg) 828.10 724.63

Phosphorous (mg) 1222.22 1052.82**

Magnesium (mg) 281.50 235.71**

Iron (mg) 15.21 13.17**



p≤ 0.01.

22

Table 2B. Health Outcomes by Food Insecurity Status for Seniors, Sample of married


(1) (2)






Suffers from depression 0.03 0.06*

At least one ADL limitation 0.61 0.82*



Congestive heart failure 0.06 0.10


Heart attack 0.14 0.09*

Cancer 0.11 0.23**


Gum disease 0.10 0.24*

Gum health? (1-excellent 5-poor) 2.60 3.61**

Psoriasis 0.04 0.03

Asthma 0.10 0.17**

Notes: Food secure is defined as 2 or fewer affirmative responses in the Core Food Security Module;

food insecure is defined as 3 or more affirmative responses. * Different from column (1), p ≤ 0.05. **

Different from column (1), p≤ 0.01.

23

Table 3A. Nutrients by Food Insecurity Status for Seniors, Sample of widowed


(1) (2)

Nutrient intakes


Protein (gm) 61.83 53.93**

Vitamin A (mcg) 668.04 517.15**

Vitamin C (mg) 85.75 67.23**

Thiamin (mg) 1.36 1.15**


Vitamin B6 (mg) 1.65 1.26**

Calcium (mg) 735.45 652.94*

Phosphorous (mg) 1034.77 913.60**

Magnesium (mg) 236.43 200.54**

Iron (mg) 13.29 10.51**



p≤ 0.01.

24

Table 3B. Health Outcomes by Food Insecurity Status for Seniors, Sample of widowed


(1) (2)



Excellent 0.06 0.03





High blood pressure 0.61 0.68




Heart attack 0.11 0.15

Cancer 0.18 0.23

Reports of chest pain 0.53 0.55

Asthma 0.11 0.09 Notes: Food secure is defined as 2 or fewer affirmative responses in the Core Food Security Module; food insecure


p≤ 0.01.

25

Table 4A. Nutrients by Food Insecurity Status for Seniors, Sample of not married or widowed


(1) (2)

Nutrient intakes

Energy Intake (kcal) 1767.45 1716.70

Protein (gm) 68.02 66.45

Vitamin A (mcg) 659.08 607.11

Vitamin C (mg) 85.17 70.98*

Thiamin (mg) 1.47 1.36

Riboflavin (mg) 2.02 1.96

Vitamin B6 (mg) 1.73 1.62

Calcium (mg) 793.57 779.28

Phosphorous (mg) 1134.35 1118.17

Magnesium (mg) 266.49 252.67

Iron (mg) 13.91 13.67



p≤ 0.01.

26

Table 4B. Health Outcomes by Food Insecurity Status for Seniors, Sample of not married or widowed


(1) (2)

Diabetic 0.17 0.24*












Cancer 0.20 0.11**




p≤ 0.01.

27

Table 5A. Nutrition Outcomes by Food Insecurity Status for Seniors, Sample Below 200% of

Poverty Line


(1) (2)

Nutrient intakes

Energy Intake (kcal) 1647.23 1555.08*

Protein (gm) 63.60 60.38*

Vitamin A (mcg) 612.35 538.71*

Vitamin C (mg) 78.11 70.29*

Thiamin (mg) 1.38 1.29*


Vitamin B6 (mg) 1.60 1.46*

Calcium (mg) 727.67 703.13


Magnesium (mg) 240.57 224.47*

Iron (mg) 13.41 12.42*



p≤ 0.01

28

Table 5B. Health Outcomes by Food Insecurity Status for Seniors, Sample Below 200% of Poverty Line


(1) (2)

Diabetic 0.20 0.28*


Excellent 0.05 0.03










Cancer 0.20 0.15**



is defined as 3 or more affirmative responses . * Different from column (1), p ≤ 0.05. ** Different from column

(1), p≤ 0.01

Table 6A. Nutrients by Food Insecurity Status for Seniors, Sample of 200% of poverty line or

more


29

(1) (2)

Nutrient intakes


Protein (gm) 72.62 65.57*

Vitamin A (mcg) 683.04 551.69*

Vitamin C (mg) 94.81 56.19**

Thiamin (mg) 1.56 1.31**


Vitamin B6 (mg) 1.89 1.55*

Calcium (mg) 836.65 791.58


Magnesium (mg) 282.15 258.11

Iron (mg) 15.16 13.29*



p≤ 0.01.

30

Table 6B. Health Outcomes by Food Insecurity Status for Seniors, Sample of 200% of poverty line or more


(1) (2)

Diabetic 0.15 0.19












Cancer 0.24 0.08**


Asthma 0.10 0.18* Notes: Food secure is defined as 2 or fewer affirmative responses in the Core Food Security Module; food insecure


p≤ 0.01.

31

Table 7A. Nutrients by Food Insecurity Status for Seniors, Sample of female


(1) (2)

Nutrient intakes


Protein (gm) 60.70 55.61**

Vitamin A (mcg) 622.51 533.51*

Vitamin C (mg) 85.11 65.54**

Thiamin (mg) 1.33 1.16**


Vitamin B6 (mg) 1.59 1.33**

Calcium (mg) 741.79 651.06**

Phosphorous (mg) 1032.76 938.21**

Magnesium (mg) 241.86 212.00**

Iron (mg) 12.96 11.18**



p≤ 0.01.

32

Table 7B. Health Outcomes by Food Insecurity Status for Seniors, Sample of female


(1) (2)













Cancer 0.21 0.15**




p≤ 0.01.

33

Table 8A. Nutrients by Food Insecurity Status for Seniors, Sample of male


(1) (2)

Nutrient intakes


Protein (gm) 81.12 70.57**

Vitamin A (mcg) 709.57 554.02**

Vitamin C (mg) 94.97 70.24**

Thiamin (mg) 1.72 1.51**

Riboflavin (mg) 2.31 2.06*

Vitamin B6 (mg) 2.07 1.71**

Calcium (mg) 877.42 831.25

Phosphorous (mg) 1332.28 1186.71**

Magnesium (mg) 302.86 261.74**

Iron (mg) 16.66 14.80*



p≤ 0.01.

34

Table 8B. Health Outcomes by Food Insecurity Status for Seniors, Sample of male


(1) (2)

Diabetic 0.18 0.25*












Cancer 0.25 0.11**




p≤ 0.01..

35

Table 9A. Nutrients by Food Insecurity Status for Seniors, Sample of black


(1) (2)

Nutrient intakes


Protein (gm) 63.69 60.09

Vitamin A (mcg) 618.30 530.84

Vitamin C (mg) 87.07 76.09

Thiamin (mg) 1.26 1.16*


Vitamin B6 (mg) 1.53 1.34**

Calcium (mg) 601.83 575.90


Magnesium (mg) 218.53 198.35*

Iron (mg) 12.18 11.35



p≤ 0.01.

36

Table 9B. Health Outcomes by Food Insecurity Status for Seniors, Sample of black


(1) (2)

Diabetic 0.29 0.32


Excellent 0.05 0.05



Suffers from depression 0.04 0.05





Coronary heart disease 0.05 0.10*


Cancer 0.14 0.11

Reports of chest pain 0.32 0.40*



p≤ 0.01.

37

Table 10A. Nutrients by Food Insecurity Status for Seniors, Sample of Hispanic


(1) (2)

Nutrient intakes


Protein (gm) 65.52 61.49

Vitamin A (mcg) 549.62 488.62

Vitamin C (mg) 84.41 69.83*


Riboflavin (mg) 1.71 1.55*


Calcium (mg) 720.80 693.73


Magnesium (mg) 250.21 237.98

Iron (mg) 12.75 12.20



p≤ 0.01.

38

Table 10B. Health Outcomes by Food Insecurity Status for Seniors, Sample of Hispanic


(1) (2)

Diabetic 0.24 0.26












Cancer 0.09 0.08




p≤ 0.01.

39

Table 11A. Nutrients by Food Insecurity Status for Seniors, Sample of white


(1) (2)

Nutrient intakes


Protein (gm) 70.70 62.79**

Vitamin A (mcg) 675.75 575.99*

Vitamin C (mg) 89.40 64.38**

Thiamin (mg) 1.54 1.38**


Vitamin B6 (mg) 1.84 1.56**

Calcium (mg) 832.19 801.37


Magnesium (mg) 274.49 240.06**

Iron (mg) 14.97 13.39*



p≤ 0.01.

40

Table 11B. Health Outcomes by Food Insecurity Status for Seniors, Sample of white


(1) (2)













Cancer 0.25 0.17*




p≤ 0.01.

41

Table 12A. Nutrients by Food Insecurity Status for Seniors, Sample of high school graduate


(1) (2)

Nutrient intakes


Protein (gm) 71.56 67.04

Vitamin A (mcg) 680.62 628.11

Vitamin C (mg) 90.98 70.71**




Calcium (mg) 843.47 861.64


Magnesium (mg) 278.39 270.31

Iron (mg) 14.90 14.48



p≤ 0.01.

42

Table 12B. Health Outcomes by Food Insecurity Status for Seniors, Sample of high school graduate


(1) (2)

Diabetic 0.15 0.18












Cancer 0.24 0.15**




p≤ 0.01.

43

Table 13A. Nutrients by Food Insecurity Status for Seniors, Sample of non-high school graduate


(1) (2)

Nutrient intakes


Protein (gm) 64.54 56.37**

Vitamin A (mcg) 597.22 476.55**

Vitamin C (mg) 72.52 63.65*

Thiamin (mg) 1.41 1.16**


Vitamin B6 (mg) 1.64 1.26**

Calcium (mg) 728.89 639.76**

Phosphorous (mg) 1067.08 932.92**

Magnesium (mg) 236.28 199.87**

Iron (mg) 13.45 10.93**



p≤ 0.01.

44

Table 13B. Health Outcomes by Food Insecurity Status for Seniors, Sample of non-high school graduate


(1) (2)













Cancer 0.20 0.12**




p≤ 0.01.

45

Table 14A. Nutrients by Food Insecurity Status for Seniors, Sample of between 60 and 65 years

of age


(1) (2)

Nutrient intakes


Protein (gm) 75.95 66.13**

Vitamin A (mcg) 635.94 556.43

Vitamin C (mg) 89.74 68.79**

Thiamin (mg) 1.56 1.35**


Vitamin B6 (mg) 1.84 1.60**

Calcium (mg) 841.14 722.88*

Phosphorous (mg) 1249.29 1082.59**

Magnesium (mg) 286.07 243.57**

Iron (mg) 14.93 13.25*



p≤ 0.01.

46

Table 14B. Health Outcomes by Food Insecurity Status for Seniors, Sample of between 60 and 65 years of

age


(1) (2)

Diabetic 0.16 0.23*







High blood pressure 0.49 0.59*

High cholesterol 0.53 0.65**




Cancer 0.15 0.08**




p≤ 0.01.

47


of age


(1) (2)

Nutrient intakes


Protein (gm) 73.06 59.77

Vitamin A (mcg) 676.93 529.02*

Vitamin C (mg) 94.16 65.68**

Thiamin (mg) 1.54 1.25**


Vitamin B6 (mg) 1.85 1.46**

Calcium (mg) 806.57 725.78

Phosphorous (mg) 1204.26 1034.64**

Magnesium (mg) 280.49 229.60**

Iron (mg) 15.10 12.49**



p≤ 0.01.

48


age


(1) (2)



Excellent 0.11 0.05*










Cancer 0.21 0.15




p≤ 0.01.

49


of age


(1) (2)

Nutrient intakes


Protein (gm) 68.10 59.55**

Vitamin A (mcg) 670.81 488.16**

Vitamin C (mg) 86.76 64.25**

Thiamin (mg) 1.48 1.21**


Vitamin B6 (mg) 1.79 1.28**

Calcium (mg) 789.13 719.07

Phosphorous (mg) 1137.58 1005.45*

Magnesium (mg) 263.30 212.62**

Iron (mg) 14.43 11.81**



p≤ 0.01.

50


age


(1) (2)

Diabetic 0.19 0.25


Excellent 0.09 0.03*





High blood pressure 0.61 0.72*





Cancer 0.26 0.18




p≤ 0.01.

51


of age


(1) (2)

Nutrient intakes


Protein (gm) 61.88 55.23**

Vitamin A (mcg) 670.34 570.51

Vitamin C (mg) 87.53 69.14*



Vitamin B6 (mg) 1.73 1.41**

Calcium (mg) 765.14 715.39

Phosphorous (mg) 1066.83 962.91*

Magnesium (mg) 245.98 224.71

Iron (mg) 13.99 12.06*



p≤ 0.01.

52


age


(1) (2)

Diabetic 0.16 0.21












Cancer 0.29 0.18**




p≤ 0.01.

53

Table 18A. Nutrients by Food Insecurity Status for Seniors, Sample of more than 80 years of age


(1) (2)

Nutrient intakes


Protein (gm) 60.32 54.13

Vitamin A (mcg) 689.73 507.87**

Vitamin C (mg) 89.70 81.24

Thiamin (mg) 1.41 1.15**


Vitamin B6 (mg) 1.73 1.26**

Calcium (mg) 764.40 666.66

Phosphorous (mg) 1049.61 909.01*

Magnesium (mg) 241.13 209.34*

Iron (mg) 13.86 9.86**



p≤ 0.01.

54

Table 18B. Health Outcomes by Food Insecurity Status for Seniors, Sample of more than 80 years of age


(1) (2)

Diabetic 0.16 0.23


Excellent 0.07 0.04


Excellent, very good, or good 0.64 0.51


At least one ADL limitation 0.80 0.89*






Cancer 0.30 0.13**




p≤ 0.01.

55

Table 19A: Effect of Food Insecurity and Other Variables on Various Nutrient Intake Outcomes

Energy Protein Vitamin A Vitamin C Thiamin Riboflavin

(1) (2) (3) (4) (5) (6)

Food insecure -76.899** -3.407** -55.084 -6.658* -0.088** -0.073

(26.469) (1.178) (36.813) (3.349) (0.029) (0.039)

Not married or widowed 37.256 0.335 33.396 4.224 0.018 0.074*

(20.228) (0.900) (27.470) (2.560) (0.022) (0.030)

Widowed 48.953* 1.475 52.273 1.571 0.047* 0.091**

(19.516) (0.869) (26.817) (2.469) (0.021) (0.029)

Income/Poverty line 36.805** 1.729** 18.799* 5.156** 0.036** 0.047**

(5.536) (0.246) (7.573) (0.700) (0.006) (0.008)

Female -430.320** -17.655** -79.236** -7.215** -0.344** -0.447**

(15.198) (0.676) (20.968) (1.923) (0.017) (0.022)

Black -162.943** -4.677** -23.111 4.451 -0.225** -0.524**

(20.596) (0.917) (28.099) (2.606) (0.022) (0.030)

Hispanic -85.729** -0.991 -66.474* 9.971** -0.124** -0.260**

(20.497) (0.912) (28.465) (2.594) (0.022) (0.030)

Other -191.265** -3.795 -50.390 18.874** -0.057 -0.488**

(45.174) (2.010) (61.169) (5.716) (0.049) (0.067)

High school graduate 111.347** 3.577** 76.176** 14.595** 0.080** 0.135**

(17.113) (0.762) (23.477) (2.165) (0.019) (0.025)

Age -16.458** -0.660** 1.337 0.289 -0.005** -0.009**

(1.169) (0.052) (1.616) (0.148) (0.001) (0.002)

Constant 2,959.884** 117.253** 506.368** 60.922** 1.925** 2.580**

(91.581) (4.076) (126.485) (11.588) (0.100) (0.135)

Notes: Number of observations is 9422. Standard errors are in parentheses. * significant at 5% level; ** significant

at 1% level.

56

Table 19A(cont): Effect of Food Insecurity and Other Variables on Various Nutrient Intake Outcomes

VitaminB6 Calcium Phosphorous Magnesium Iron

(7) (8) (9) (10) (11)

Food insecure -0.133** -1.478 -38.608* -10.005* -0.740*

(0.043) (18.128) (19.095) (4.688) (0.305)

Not married or widowed 0.033 34.066* 14.127 7.496* -0.058

(0.033) (13.854) (14.593) (3.583) (0.233)

Widowed 0.073* 21.483 19.950 1.586 0.319

(0.032) (13.366) (14.079) (3.457) (0.225)

Income/Poverty line 0.073** 24.741** 28.926** 9.487** 0.372**

(0.009) (3.792) (3.994) (0.981) (0.064)

Female -0.420** -105.099** -254.768** -49.301** -3.185**

(0.025) (10.409) (10.964) (2.692) (0.175)

Black -0.222** -207.444** -209.135** -44.035** -2.259**

(0.033) (14.106) (14.858) (3.648) (0.237)

Hispanic -0.100** -36.381** -26.341 1.935 -1.052**

(0.033) (14.038) (14.787) (3.631) (0.236)

Other -0.143* -160.164** -142.555** 8.830 -0.716

(0.073) (30.939) (32.588) (8.001) (0.521)

High school graduate 0.153** 56.984** 69.313** 25.888** 0.962**

(0.028) (11.721) (12.345) (3.031) (0.197)

Age -0.002 -2.333** -8.300** -1.428** -0.033*

(0.002) (0.801) (0.843) (0.207) (0.013)

Constant 1.889** 850.065** 1,732.671** 352.097** 17.408**

(0.148) (62.723) (66.066) (16.221) (1.056)


at 1% level.

57

Table 19B: Effect of Food Insecurity and Other Variables on Various Health Outcomes

Diabetic Excellent Excellent or

very good

Excellent,

very good, or

good

Depression ADL

limitations

(1) (2) (3) (4) (5) (6)

Food insecure 0.009 -0.008 -0.083** -0.084** 0.018* 0.142**

(0.014) (0.011) (0.019) (0.020) (0.007) (0.015)

Not married or widowed -0.030** 0.000 -0.014 -0.051** 0.013* 0.017

(0.010) (0.007) (0.014) (0.015) (0.006) (0.013)

Widowed -0.003 -0.011 -0.037** -0.058** 0.006 0.019

(0.011) (0.007) (0.013) (0.015) (0.005) (0.013)

Income/Poverty line -0.020** 0.015** 0.041** 0.047** -0.009** -0.033**

(0.003) (0.002) (0.004) (0.004) (0.001) (0.004)

Female -0.013 -0.011 -0.005 -0.002 0.016** 0.096**

(0.008) (0.006) (0.011) (0.011) (0.004) (0.010)

Black 0.122** -0.020** -0.117** -0.109** -0.009 -0.035*

(0.013) (0.007) (0.012) (0.016) (0.005) (0.014)

Hispanic 0.084** -0.014* -0.140** -0.161** 0.005 -0.052**

(0.012) (0.007) (0.012) (0.016) (0.005) (0.014)

Other 0.073** -0.027* -0.102** -0.110** -0.003 -0.036

(0.028) (0.012) (0.024) (0.033) (0.010) (0.030)

High school graduate -0.032** 0.029** 0.109** 0.139** 0.007 -0.037**

(0.009) (0.006) (0.011) (0.012) (0.004) (0.011)

Age -0.002** -0.001* -0.002 -0.003** -0.001* 0.010**

(0.001) (0.000) (0.001) (0.001) (0.000) (0.001)

N 10625 8702 8702 8702 10625 10625

Notes: Standard errors are in parentheses. * significant at 5% level; ** significant at 1% level.

58

Table 19B(cont): Effect of Food Insecurity and Other Variables on Various Health Outcomes

High

Blood

Pressure

High

Cholesterol

Congestive Heart

Failure

Coronary

Heart

Disease

Heart

Attack

(7) (8) (9) (10) (11)

Food insecure 0.033 -0.006 0.028** 0.024 0.053**

(0.018) (0.021) (0.011) (0.013) (0.013)

Not married or widowed -0.017 -0.004 -0.002 -0.021** 0.007

(0.014) (0.015) (0.007) (0.008) (0.009)

Widowed 0.001 -0.013 0.029** 0.009 0.022**

(0.014) (0.015) (0.007) (0.008) (0.008)

Income/Poverty line -0.009* -0.007 -0.011** -0.003 -0.013**

(0.004) (0.004) (0.002) (0.002) (0.002)

Female 0.063** 0.037** -0.034** -0.078** -0.084**

(0.011) (0.012) (0.006) (0.006) (0.006)

Black 0.179** -0.032* 0.002 -0.054** -0.030**

(0.013) (0.016) (0.007) (0.007) (0.007)

Hispanic -0.016 -0.019 -0.029** -0.046** -0.054**

(0.014) (0.016) (0.006) (0.007) (0.006)

Other 0.024 -0.045 -0.020 -0.014 -0.040**

(0.030) (0.033) (0.013) (0.016) (0.013)

High school graduate -0.000 0.013 -0.012 -0.005 0.001

(0.012) (0.013) (0.006) (0.007) (0.007)

Age 0.005** -0.005** 0.003** 0.002** 0.003**

(0.001) (0.001) (0.000) (0.000) (0.000)

N 10625 10625 10625 10625 10625


59


Cancer Chest pain Gum

Disease

Gum Health (1-

excellent 5-poor)

Psoriasis Asthma

(12) (13) (14) (15) (16) (17)

Food insecure 0.004 0.118** 0.016 0.133 -0.004 0.057** (0.016) (0.018) (0.028) (0.095) (0.012) (0.013) Not married or widowed -0.004 0.003 0.053* 0.158* 0.009 0.016 (0.011) (0.013) (0.024) (0.073) (0.012) (0.009) Widowed -0.026** -0.005 0.020 0.106 0.022 -0.007 (0.010) (0.012) (0.025) (0.076) (0.014) (0.008) Income/Poverty line 0.012** -0.016** -0.010 -0.143** -0.002 -0.006* (0.003) (0.004) (0.006) (0.020) (0.003) (0.002) Female -0.026** 0.022* -0.021 -0.210** -0.014 0.040** (0.008) (0.010) (0.017) (0.057) (0.008) (0.006) Black -0.070** -0.029* 0.032 0.386** -0.031** -0.004 (0.009) (0.013) (0.025) (0.078) (0.007) (0.008) Hispanic -0.127** -0.086** 0.013 0.363** -0.014 -0.035** (0.009) (0.012) (0.023) (0.079) (0.008) (0.008) Other -0.113** -0.010 0.058 0.492** 0.007 0.029 (0.014) (0.028) (0.049) (0.139) (0.020) (0.020) High school graduate 0.021* -0.012 -0.003 -0.212** 0.002 0.005 (0.009) (0.011) (0.020) (0.067) (0.009) (0.007) Age 0.008** -0.000 -0.007** -0.004 -0.001 -0.002** (0.001) (0.001) (0.001) (0.004) (0.001) (0.000) Constant 3.635**

(0.344)

N 8265 10298 1641 1641 1874 10302


60

Table 20A: Effect of Food Insecurity and Other Variables on Various Nutrient Intake Outcomes on

population below 200% of poverty line

Energy Protein Vitamin A Vitamin C Thiamin Riboflavin

(1) (2) (3) (4) (5) (6)

Food insecure

-78.427** -3.708** -77.524 -8.079* -0.082** -0.075

(29.861) (1.296) (40.381) (3.746) (0.030) (0.042)

Not married or

widowed

60.083* 0.750 13.976 4.813 0.010 0.130**

(28.233) (1.225) (38.009) (3.541) (0.028) (0.040)

Widowed 50.128 1.273 34.466 3.378 0.066* 0.128**

(27.868) (1.210) (37.847) (3.496) (0.028) (0.040)

Income/Poverty line 51.172* 1.189 -27.100 5.422 0.054* 0.081*

(25.286) (1.098) (34.369) (3.172) (0.025) (0.036)

Female -382.346** -15.670** -18.417 -5.562 -0.296** -0.389**

(22.821) (0.991) (30.989) (2.863) (0.023) (0.032)

Black -145.507** -4.158** -37.519 7.035 -0.189** -0.522**

(30.078) (1.306) (40.240) (3.773) (0.030) (0.043)

Hispanic -64.718* 0.225 -40.702 12.062** -0.098** -0.231**

(28.185) (1.223) (38.350) (3.535) (0.028) (0.040)

Other -102.003 2.385 13.569 27.607** 0.062 -0.343**

(67.319) (2.922) (88.805) (8.444) (0.067) (0.095)

High school

graduate

117.012** 3.614** 56.728 12.103** 0.092** 0.161**

(23.159) (1.005) (30.927) (2.905) (0.023) (0.033)

Age -14.469** -0.556** 0.757 -0.005 -0.005** -0.010**

(1.762) (0.076) (2.392) (0.221) (0.002) (0.002)

Constant 2,762.744** 108.863** 593.204** 77.260** 1.836** 2.541**

(137.540) (5.970) (186.817) (17.252) (0.137) (0.195)


at 1% level.

61

Table 20A(cont): Effect of Food Insecurity and Other Variables on Various Nutrient Intake Outcomes on

population below 200% of poverty line

VitaminB6 Calcium Phosphorous Magnesium Iron

(7) (8) (9) (10) (11)

Food insecure -0.127** -9.497 -49.312* -13.703** -0.739*

(0.040) (19.536) (21.203) (5.129) (0.320)

Not married or widowed 0.047 52.610** 34.806 8.871 0.008

(0.038) (18.470) (20.047) (4.849) (0.303)

Widowed 0.096* 33.390 23.748 0.684 0.551

(0.037) (18.232) (19.788) (4.786) (0.299)

Income/Poverty line 0.065 38.986* 26.010 7.212 0.635*

(0.034) (16.542) (17.955) (4.343) (0.271)

Female -0.333** -85.655** -219.609** -40.053** -2.825**

(0.031) (14.930) (16.204) (3.920) (0.245)

Black -0.208** -189.213** -191.786** -37.428** -1.712**

(0.040) (19.678) (21.358) (5.166) (0.323)

Hispanic -0.091* 13.191 9.983 8.351 -0.674*

(0.038) (18.439) (20.013) (4.841) (0.302)

Other -0.016 -83.136 -55.916 29.008* 0.700

(0.090) (44.040) (47.800) (11.562) (0.722)

High school graduate 0.129** 79.397** 76.628** 25.931** 1.056**

(0.031) (15.151) (16.444) (3.978) (0.248)

Age -0.005* -0.929 -7.068** -1.382** -0.034

(0.002) (1.153) (1.251) (0.303) (0.019)

Constant 2.034** 699.256** 1,614.758** 345.427** 16.489**

(0.184) (89.980) (97.662) (23.623) (1.475)


at 1% level.

62

Table 20B: Effect of Food Insecurity and Other Variables on Various Health Outcomes on population

below 200% of poverty line

Diabetic Excellent Excellent or

very good

Excellent,

very good, or

good

Depression ADL

limitations

(1) (2) (3) (4) (5) (6)

Food insecure 0.025 -0.004 -0.052** -0.068** 0.022* 0.114**

(0.017) (0.009) (0.017) (0.023) (0.009) (0.015)

Not married or

widowed

-0.041** 0.002 0.004 -0.021 0.017 0.009

(0.015) (0.008) (0.016) (0.021) (0.009) (0.016)

Widowed -0.006 -0.011 -0.023 -0.014 0.007 0.021

(0.016) (0.008) (0.016) (0.021) (0.008) (0.016)

Income/Poverty

line

0.001 0.006 0.031* 0.090** -0.017* -0.068**

(0.014) (0.007) (0.015) (0.019) (0.007) (0.015)

Female 0.011 -0.005 -0.019 -0.019 0.021** 0.071**

(0.013) (0.007) (0.013) (0.017) (0.006) (0.013)

Black 0.101** 0.001 -0.056** -0.063** -0.019** -0.031

(0.019) (0.009) (0.015) (0.022) (0.007) (0.018)

Hispanic 0.071** -0.004 -0.100** -0.146** 0.003 -0.054**

(0.017) (0.008) (0.014) (0.021) (0.008) (0.017)

Other 0.056 -0.014 -0.056 -0.048 -0.012 -0.041

(0.040) (0.015) (0.029) (0.046) (0.014) (0.041)

High school

graduate

-0.029* 0.015* 0.073** 0.123** 0.016* -0.028*

(0.013) (0.007) (0.013) (0.017) (0.007) (0.014)

Age -0.003** 0.000 0.002* -0.001 -0.001* 0.008**

(0.001) (0.001) (0.001) (0.001) (0.000) (0.001)

N 4,879 4,075 4,075 4,075 4,879 4,879

Notes: Standard errors in parentheses * significant at 5% level; ** significant at 1% level.

63

Table 20B(cont): Effect of Food Insecurity and Other Variables on Various Health Outcomes on population

below 200% of poverty line

High

Blood

Pressure

High

Cholesterol

Congestive Heart

Failure

Coronary

Heart

Disease

Heart

Attack

(7) (8) (9) (10) (11)

Food insecure 0.051** 0.002 0.030* 0.026 0.058**

(0.020) (0.024) (0.013) (0.013) (0.016)

Not married or

widowed

0.013 0.008 -0.007 -0.029** -0.004

(0.019) (0.022) (0.011) (0.010) (0.012)

Widowed 0.027 -0.000 0.017 -0.002 0.018

(0.018) (0.021) (0.011) (0.011) (0.012)

Income/Poverty line -0.000 0.023 -0.015 -0.023* -0.008

(0.017) (0.019) (0.010) (0.010) (0.011)

Female 0.080** 0.051** -0.028** -0.050** -0.088**

(0.015) (0.017) (0.009) (0.009) (0.010)

Black 0.176** -0.018 -0.015 -0.060** -0.042**

(0.018) (0.023) (0.011) (0.009) (0.011)

Hispanic -0.034 -0.011 -0.043** -0.063** -0.082**

(0.019) (0.021) (0.010) (0.009) (0.010)

Other 0.025 -0.001 -0.053** -0.033 -0.063**

(0.043) (0.048) (0.015) (0.018) (0.017)

High school

graduate

-0.003 -0.005 -0.003 -0.005 0.001

(0.016) (0.017) (0.009) (0.009) (0.010)

Age 0.003** -0.007** 0.003** 0.001* 0.002**

(0.001) (0.001) (0.001) (0.001) (0.001)

N 4,879 3,938 4,821 4,808 4,854


64


Cancer Chest pain Gum

Disease

Gum Health (1-

excellent 5-poor)

Psoriasis Asthma

(12) (13) (14) (15) (16) (17)

Food insecure 0.012 0.121** -0.010 0.076 -0.007 0.048**

(0.016) (0.020) (0.032) (0.109) (0.015) (0.014)

Not married or

widowed -0.019 0.005 0.110** 0.111 0.001 0.022

(0.013) (0.018) (0.040) (0.110) (0.016) (0.012)

Widowed -0.031* 0.008 0.012 0.038 0.005 -0.010

(0.012) (0.018) (0.040) (0.116) (0.017) (0.011)

Income/Poverty line 0.005 -0.015 0.028 -0.158 -0.009 -0.011

(0.012) (0.016) (0.032) (0.104) (0.015) (0.011)

Female -0.007 0.031* -0.003 -0.203* -0.012 0.048**

(0.011) (0.015) (0.028) (0.092) (0.013) (0.009)

Black -0.062** -0.052** 0.008 0.308* -0.035** -0.011

(0.012) (0.019) (0.038) (0.122) (0.010) (0.012)

Hispanic -0.120** -0.113** -0.003 0.204 -0.031* -0.042**

(0.011) (0.017) (0.035) (0.115) (0.012) (0.011)

Other -0.123** -0.048 0.118 0.461* -0.015 0.034

(0.013) (0.039) (0.078) (0.190) (0.017) (0.029)

High school

graduate 0.019 -0.013 -0.028 -0.250** 0.011 0.007

(0.011) (0.015) (0.029) (0.091) (0.013) (0.010)

Age 0.006** -0.003* -0.009** -0.007 -0.001 -0.002**

(0.001) (0.001) (0.002) (0.007) (0.001) (0.001)

Constant 4.003**

(0.551)

N 4,872 4,865 654 660 815 4,873


65

135

01

60

01

85

0

Ene

rgy

99-02 03-06 07-10

Food secure Food insecure

Figure 1: Energy (kcal) by Food Insecurity Status for Seniors, 1999-2010

66

57

62

67

72

Pro

tein

99-02 03-06 07-10


Figure 2: Protein (gm) by Food Insecurity Status for Seniors, 1999-2010

67

600

650

700

750

800

850

Calc

ium

99-02 03-06 07-10


Figure 3: Calcium (mg) by Food Insecurity Status for Seniors, 1999-2010

68

11

12

13

14

15

Iro

n

99-02 03-06 07-10


Figure 4: Iron (mg) by Food Insecurity Status for Seniors, 1999-2010

69

10

20

30

Dia

bete

s (

%)

99-02 03-06 07-10


Figure 5: Diabetes Status by Food Insecurity Status for Seniors, 1999-2010

70

05

10

15

Dep

ressio

n (

%)

99-02 03-06 07-10


Figure 6: Suffers from Depression by Food Insecurity Status for Seniors, 1999-2010

71

60

70

80

90

Any A

DL

(%

)

99-02 03-06 07-10


Figure 7: At least one ADL Limitation by Food Insecurity Status for Seniors, 1999-2010

72

45

55

65

Hig

h B

loo

d P

ressu

re (

%)

99-02 03-06 07-10


Figure 8: High Blood Pressure by Food Insecurity Status for Seniors, 1999-2010

73

46

81

01

21

41

6

Con

ge

stive

Hea

rt F

ailu

re (

%)

99-02 03-06 07-10


Figure 9: Congestive Heart Failure by Food Insecurity Status for Seniors, 1999-2010

74

68

10

12

14

16

18

20

Hea

rt A

ttack (

%)

99-02 03-06 07-10


Figure 10: Heart Attack by Food Insecurity Status for Seniors, 1999-2010

75

20

30

40

50

60

Che

st

Pain

(%

)

99-02 03-06 07-10


Figure 11: Chest Pain by Food Insecurity Status for Seniors, 1999-2010

76

10

15

20

25

Asth

ma

(%

)

99-02 03-06 07-10


Figure 12: Asthma by Food Insecurity Status for Seniors, 1999-2010

77

About the Authors

James P. Ziliak, Ph.D., holds the Carol Martin Gatton Endowed Chair in Microeconomics in the

Department of Economics and is Founding Director of the Center for Poverty Research at the

University of Kentucky. He earned received his BA/BS degrees in economics and sociology

from Purdue University, and his Ph.D. in Economics from Indiana University. He served as

assistant and associate professor of economics at the University of Oregon, and has held visiting

positions at the Brookings Institution, University College London, University of Michigan, and

University of Wisconsin. His research expertise is in the areas of labor economics, poverty, food

insecurity, and tax and transfer policy. Recent projects include the causes and consequences of

hunger among older Americans; trends in earnings and income volatility in the U.S.; trends in

the antipoverty effectiveness of the social safety net; the origins of persistent poverty in America;

and regional wage differentials across the earnings distribution. He is editor of Welfare Reform

and its Long Term Consequences for America’s Poor published by Cambridge University Press

(2009) and Appalachian Legacy: Economic Opportunity after the War on Poverty published by

Brookings Institution Press (2012).

Craig Gundersen, Ph.D., is Professor in the Department of Agricultural and Consumer

Economics at the University of Illinois and Executive Director of the National Soybean Research

Laboratory. Previously, he was at the Economic Research Service (ERS) of the USDA and at

Iowa State University. Dr. Gundersen's research is primarily focused on the causes and

consequences of food insecurity and on evaluations of food assistance programs. Among other

journals, he has published in Journal of the American Statistical Association, Journal of Human

Resources, Journal of Health Economics, Journal of Econometrics, American Journal of

Agricultural Economics, Journal of Nutrition, Pediatrics, Demography, Obesity Reviews,

Journal of the American Dietetic Association, and American Journal of Public Health. His work

has been supported by over $15 million in external funding from various government and non-

government sources.

Contact information:

Professor James P. Ziliak Professor Craig Gundersen

Center for Poverty Research Department of Agriculture and Consumer Economics

University of Kentucky University of Illinois

Mathews Building, Suite 300 323 Mumford Hall

Lexington, KY 40506-0047 1301 W. Gregory Dr.

(859) 257-6902 Urbana, IL 61801

Email: [email protected] (217) 333-2857/ Email: [email protected]

mailto:[email protected]

mailto:[email protected]

Documents

The Health Consequences of Senior Hunger in the United ... · heart disease, heart attack cancer, asthma, gum disease, and psoriasis.1 Other reports are from the respondent’s own